Module 5 Flashcards
Where may pain from sitting originate from?
the sacrum and coccyx of the vertebral column
Why may pain from sitting originate at the sacrum and coccyx?
because these structures are weight-bearing, and are integral to functions such as walking, standing and sitting
The Sacrum
large bone located at the terminal part of the vertebral column
- very thick, which supports and transmits weight of the body
- composed of 5 fused sacral vertebrae
What aspect of the body pelvis does the sacrum form?
the posterior aspect
What does the sacrum articulate with?
- the ilium bilaterally
- the 5th lumbar vertebrae (L5) at its base
Features of the sacrum
- Sacral canal
- Sacral foramina
- Sacral cornua
- Promonotory
Sacral Canal
a continuation of the vertebral canal terminating at the sacral hiatus
- protect the cauda equina and the filum terminale
Sacral foramina
4 sacral foramina are located lateral to the fused sacral bodies on both the anterior and posterior surface
- decrease in size - the most superior foramina being the largest
What exits the sacral foramina?
the anterior and posterior rami
Sacral cornua
two bony processes
- palpated by clinicians as an anatomical landmark when administering injections into the sacral hiatus
Promontory
where the upper border of the sacrum articulated with the L5 vertebral body - the promontory projects forward, decreasing the anteroposterior diameter of the pelvic brim
Female sacral promontory
considerable obstetric importance
- used when measuring the size of the pelvis
The Coccyx
composed of 4 fused rudimentary coccygeal vertebrae, which articulate with the sacrum superiorly at the sacrococcygeal joint
- much smaller than the sacrum
- attachment site for ligaments and muscles (pelvic floor muscles)
“tailbone”
Movement at the coccyx
small and variable amount of flexion and extension occurs at the sacrococcygeal joint, especially when sitting
Moving superior to inferior down the vertebral column, what changes?
The vertebral body size increases, and the vertebral foramen size decreases
Why does the size of the vertebral body increase moving superior to inferior?
to support the increasing weight
Why does the size of the vertebral foramen decrease moving from superior to inferior?
to support the spinal cord diameter decreasing as spinal nerves exit to their respective regions of the body
What happens with a smaller vertebral foramen?
blockage to the foramen could irritate the nerves in the lumbar region
- resulting in lumbar back pain
Accessory ligaments of the vertebral column
strong fibrous bands of tissue that stabilize the vertebral column and protect the intervertebral discs
3 major ligaments of the vertebral column involved in flexion and extension of the back
- Ligamentum Flavum
- Anterior Longitudinal Ligament
- Posterior Longitudinal Ligament
Calcified ligament
ligaments often calcify later in life causing a loss of flexibility
- if calcified ligaments irritate the neighbouring spinal nerves it can cause chronic pain
Lumbar Spinal Stenosis
the narrowing of the vertebral canal in the lumbar region
What is lumbar spinal stenosis caused by?
- extra bone and/or tissue growth in the vertebral canal from the calcification of the ligamentum flavum
- outgrowth of bone
- overcrowding can irritate the spinal cord and associated spinal nerves
Symptoms of lumbar spinal stenosis
- compression of SC causes numbess and weakness in lower limb
- pain localized to the lower back
- symptoms are worse when weight bearing (walking and standing)
- but are relieved when bending forward
Function of the extrinsic muscles of the back
movement of the upper extremities
Extrinsic muscles of the back
- Latissimus dorsi
- Trapezius
- Rhomboid minor
- Levator scapulae
- Rhomboid major
The Latissimus Dorsi
broad, triangular-shaped extrinsic muscle covering the lumbar region and inferior portion of the thoracic cage
- has varying muscle fiber directions due to many origin points (all share a common insertion point)
What is the largest point of origin for the latissimus dorsi?
broad fascial sheath (thoracolumbar fascia)
Thoracolumbar fascia
made from multiple crosshatched layers of collagen
- plays an important role in stabilization and load transfer
Insertion point of all the muscle fibres of the latissimus dorsi?
the inter-tubercular sulcus (bicipital groove) of the humerus
Latissimus Dorsi Strain
causes pain in the latissimus dorsi
Causes of a latissimus dorsi strain
- overuse
- individuals with poor posture are at higher risk of straining this muscle
Actions of the latissimus dorsi
- Extension
- Adduction
- Medial rotation
Symptoms of a latissimus dorsi strain
- pain in lower back that could radiate upward to the scapula
- pain with lateral flexion of the back
- pain with extension, adduction and rotation of the arm
Erector spinae muscles
comprised of 3 deep muscles in the back organized into parallel columns on either side of the vertebral column
Erector spinae muscles from lateral to medial
- Iliocostalis
- Longissimus
- Spinalis
Action of the erector spinae muscles
responsible for extending (straightening) the vertebral column
The illiocostalis muscle
longest and widest of the three erector spinae muscles
- divided into 3 divisions
3 divisions of iliocostalis
- Cervicis
- Thoracis
- Lumborum
- named corresponding to the vertebral column segments
Iliocostalis Muscle Strain
location of pain diffferents depending on what region of the muscle is strained
Cause of an iliocostalis muscle strain
- overuse
- poor posture
Symptoms of an iliocostalis muscle strain
- back pain (especially after the heavy lifting)
- decreased ROM of the spine
- pain that worsens when sitting for long periods, standing or climbing stairs
2 commonly injured regions of the iliocostalis muscle
- Iliocostalis thoracis
- Iliocostalis lumborum
Iliocostalis thoracis injury
pain from a strain here would be felt along the medial border of the scapula and posterior thorax
- pain may be referred to the anterior thorax if the strained muscle irritates underlying intercostal nerves
Iliocostalis lumborum injury
pain from a strain here can be felt in the sacroiliac region (lumbar spin to top of buttocks)
Difference between a latissimus dorsi strain and a iliocostalis thoracis strain and iliocostalis lumborum strain
- Latissimus dorsi strain: presents superolaterally, especially during movement at the shoulder joint
- Iliocostalis thoracis strain: pain is in anterior and posterior thorax
- Iliocostalis lumborum strain: pain can radiate into sacroliliac region
Treatment of an iliocostalis lumborum strain
- ice
- NSAIDs
- corticosteroid injections if pain persists
- massage therapy to target the iliocostal muscle to alleviate pain
- exercise (yoga) to help regain strength
The axilla (armpit)
pyramidal shaped space between the upper thorax and arm
- passageway for major nerves and blood vessels to enter and leave the upper limb
Anterior border of the axilla
the pectoralis major muscle
Posterior border of the axilla
- subscapularis
- latissimus dorsi
- teres major
Medial border of the axilla
Serratus Anterior
Lateral border of the axilla
Intertubercular sulcus of the humerus
apex of the axilla
base of neck
Base of the axilla
Skin of armpit
Contents of the axilla
- arteries
- veins
- lymph nodes
- nerves
What lymph nodes are located in the axilla?
the axillary lymph nodes
Axillary lymph nodes
drain the breast
The brachial plexus
network of nerves that supplies motor and sensory innervation to the upper limb
- begins in the neck, passes through axilla and terminal branches run through the entire upper limb
5 parts of the brachial plexus
- Roots
- Trunks
- Divisions
- Cords
- Branches
Roots of the brachial plexus
formed by the ventral rami of spinal nerves C5-T1
- the five spinal nerve roots leave the spinal cord through the intervertebral foramen
Trunks of the brachial plexus
each trunk branches into an anterior and posterior division
- nerve fibres for anterior muscles are sorted from those for the posterior muscles of the arm, forearm and hand
Divisions of the brachial plexus
3 anterior and 3 posterior divisions from each trunk
- these divisions correspond to the anterior and posterior compartments of the arm, forearm and hand
Cords of the brachial plexus
named by their position (medial, lateral, posterior) relative to the axillary artery
When do the anterior and posterior divisions become the cords?
when they enter the axilla, they combine together to form 3 cords
Branches of the brachial plexus
3 cords give rise to 5 major terminal nerve branches
5 branches of the brachial plexus
- Musculocutaneous
- Radial
- Axillary
- Median
- Ulnar
2 compartment in the arm
- Posterior compartment
- Anterior compartment
Posterior compartment of the arm
involved in the extension of the forearm at the elbow joint
Anterior compartment of the arm
involved in the flexion of the forearm at the elbow joint and supination of forearm
- minor role in adduction and flexion of the arm
The Musculocutaneous Nerve
motor innervation of the anterior compartment (flexion) of the arm
The Radial Nerve
motor innervation of the posterior compartment (extension)of the arm and forearm
The Axillary Nerve
motor innervation to…
1. deltoid (abduction)
2. teres minor (lateral rotation
The Ulnar Nerve
motor innervation of…
1. two muscles of the anterior compartment of the forearm
2. most muscles of intrinsic muscles of the hand
The Median Nerve
motor innervation to…
1. most muscles of the anterior compartment of the forearm
2. 5 of the intrinsic muscles of the hand
What happens if there is damage to the anterior division of the brachial pelxus?
damage the medial cord and therefore the median and ulnar nerves
- changes in flexion at the hand
- changes in pronation at the forearm
- changes in the ability to abduct/adduct the hand
Symptoms of Posterior Cord Nerve Damage
- paralysis of the deltoid muscle (abduction) - innervated by axillary nerve
- paralysis of the muscles of the posterior compartment of the arm (extension)
- cutaneous deficit
What is the upper limb supplied by?
branches from the subclavian arteries
Arterial supply from the subclavian artery as it supplies the upper limb
- Subclavian a.
- Axillary a.
- Brachial a.
- Radial & Ulnar a.
what is the preferred pulse point?
the radial artery (wrist)
why is the radial artery the preferred pulse point?
due to its large size and proximity to the surface of the arm
Axillary Artery Damage
causes major bleeding
Symptoms of axillary artery damage
- bruising caused by pooling of blood under skin
- swelling/redness from occlusion (blood clot) disrupting blood flow
- elevated temperature due to disruption of circulation or pooling of blood
- weak pulse - low radial pulse reading (reduced blood flow)
Venous drainage of the upper limb
interconnected pathway that eventually forms the subclavian vein
What happens after the subclavian vein is formed?
venous blood continues into the brachiocephalic vein and then the SVC before draining to the heart
venous drainage (upwards from hadns)
- Radial v. & Ulnar v.
- Cephalic v.
- Basilic v.
- Median Cubital v.
- Brachial v.
- Axillary v.
- Subclavian v.
- SVC
- Heart
Symptoms of damage to the venous drainage
- pooling of blood near the vein
- improper or slow return to the heart (bulging veins)
Treatment for Damage to the Posterior Cord of the Brachial Plexus
- Surgery
- Physiotherapy
Surgery for Damage to the Posterior Cord
by repairing the posterior cord, the functions of the downstream axillary nerve and radial nerve may be restored
- regain ability to abduct arm, extend forearm, and extend hand
Physiotherapy for Damage to the Posterior Cord
- following surgery, there may be residual functional deficits
- strengthens the muscles that are affected and restored the function
